Pitfalls of Preferred Provider Networks for Injured Illinois Workers

The Illinois Legislature passed a bill in June 2011 reforming the state's workers' compensation system in an effort to save money. One of the major changes that the new bill instituted is that it allows employers to establish preferred provider networks to dictate where injured workers can receive treatment related to workers' compensation claims.

Preferred provider networks (PPNs) (also called preferred provider programs or PPPs) are groups of health care providers that employers or insurance companies select as the ones where injured employees are to receive treatment. The insurer or employer then submits the list to the state for approval. Once the state has approved the list, the insurer or employer can require the employee to use one of these providers if he or she is injured on the job.

After a worker files a workers' compensation claim, an employer needs to inform the employee in writing that he or she has the right to consult two care providers within the network. If the injured worker consults with a provider within the network and wants to seek a second opinion, he or she is free to consult another provider in the network as the employee's second choice.

A worker may opt out of the employer's PPN if he or she desires to see a provider not in the network. However, the new law builds in disincentives for workers to opt out of the PPN. Under Illinois law, an injured employee has the right to see two doctors of his or her choosing for a workplace injury, in addition to any other providers to whom those doctors refer the patient. The new law regarding PPNs does not technically change the number of doctors an injured worker may consult. However, if a worker chooses not to use a provider in the PPN, that choice counts as the worker's first choice of doctor — meaning that the worker may only consult one doctor outside of the PPN for his or her treatment.

In essence PPNs rob injured workers of the freedom to select their own care providers and puts that responsibility almost solely in the employer's hands. By creating lists of approved providers, the danger exists that employers and insurers may select only those providers they know will keep costs low by offering only minimal treatment for workers and declaring that workers are able to return to work before it is truly safe for workers to do so.

While some see the new bill as a way for employers to begin to save money on workers' compensation claims, such savings comes at the cost of employees' basic right to choose their doctors.